An official site of the Journal of Vascular and Interventional Radiology. We offer article summaries and commentary on current and past articles that impact the practice of VIR. Our goal is to provide current, clinically focused information and commentary on the latest developments in IR that can change your practice.

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Thursday, December 31, 2015

Bland Embolization as a Bridge to Transplantation

In the latest issue of JVIR, researchers from Duke evaluated the effectiveness of bland embolization as a bridge to transplantation in 117 patients with HCC that underwent treatment while within Milan criteria. Superselective embolization was performed in 128 of 181 procedures. PVA particles were the most common embolic used (132 of 181) with sizes ranging from 150-250 µm (n=111), 45-150 µm (n=16), and 250-355 µm (n=1). 40 µm embozene and 100-300 µm embospheres were also used in some procedures. Follow-up imaging was evaluated to determine if patients progressed beyond Milan criteria in an intent-to-transplant analysis. They found that post-embolization, 87% and 78% of patients still fell within Milan criteria at 6 and 12 months respectively. The median time to disease progression beyond Milan criteria was 22.6 months (95% confidence interval, 16.2-29 mo). 34 of 117 (29%) had eventual transplant at a median of 3.3 mo (range, 0.5 – 20.9 mo). The authors concluded that bland embolization has a comparable efficacy versus other embolotherapies as a bridging strategy to maintain HCC within Milan criteria.

Commentary:

A large portion of centers use TACE as the preferred noncurative locoregional treatment when surgical resection or locally ablative therapies are not feasible or as a bridge to transplantation. This manuscript is yet in another series of papers showing that there is a lack of evidence of superiority of chemoembolization versus bland embolization in prolonging survival. There is a significant increase in rate of adverse events when perform TACE versus TAE in addition to an increase in overall cost of the procedure. Given these factors, an article supporting bland embolization as a bridge to transplantation is noteworthy. While there are several limitations of the current study (multiple different embolic agents, no defined criteria for using TAE versus TACE, and a small number of patients going on to receive transplant)​ the results are an argument for bland embolization even if reserved for patients thought likely to receive a transplant if kept within Milan criteria.